A medicine best known for treating depression may also help protect mental health after a serious physical injury.
In a small early study, trauma patients who took fluoxetine, commonly sold under the brand name Prozac, reported fewer symptoms linked to post-traumatic stress during the year after they were injured.
The researchers also found lower levels of pain among people receiving the medicine. The findings raise the possibility that treatment started soon after a traumatic injury could reduce some of the emotional problems that sometimes develop during recovery.
Serious injuries can affect much more than bones, muscles and other physical tissues. A sudden car crash, fall or other traumatic event can leave people struggling with fear, disturbing memories, poor sleep, anxiety or a feeling that they are constantly on alert.
Some people eventually develop post-traumatic stress disorder, or PTSD. Symptoms can include unwanted memories of the event, nightmares, avoiding reminders of what happened, emotional distress and strong physical reactions to situations that bring the trauma back to mind.
Researchers at the University of Florida wanted to explore whether doctors could intervene before these symptoms became severe. Study leader Dr. Jennifer Hagen said the goal was to move from reacting to mental health problems after they develop toward trying to reduce them earlier.
The team had previously investigated a training program designed to strengthen emotional resilience after injury. That approach did not produce a clear measurable improvement in depression or post-traumatic stress symptoms, so the researchers turned to medication.
They chose fluoxetine, a widely used antidepressant that changes the activity of serotonin, a chemical messenger involved in mood and other brain functions. Fluoxetine is commonly used for depression and several other mental health conditions.
The researchers recruited 68 adults who had been treated at the UF Health Shands Level I Trauma Center after serious injuries. Examples included broken arms or legs and fractures of the pelvis.
Participants were randomly assigned to receive either fluoxetine or calcium for nine months. The researchers then followed them for another three months to examine what happened after the treatment period ended.
The study faced a major challenge because many participants did not remain through the entire follow-up period. Thirty-five people were still being followed at six months, and only 29 contributed information to the final assessment at one year.
Among those who remained, people assigned to fluoxetine showed a statistically significant reduction in post-traumatic stress symptoms across the year. Symptoms among participants in the calcium comparison group stayed roughly at the same level.
The study was randomized, which is an important strength because random assignment can reduce differences between treatment groups. However, it was not blinded, meaning both the researchers and the participants knew who was receiving fluoxetine and who was receiving calcium.
That matters because expectations can influence how people describe symptoms such as pain, anxiety and distress. The small number of participants who completed the study also makes it difficult to know whether the findings would apply to the much larger and more diverse population of trauma patients.
The researchers also noted that recruiting people for a study involving antidepressants can be difficult. Mental health stigma may make some patients uncomfortable with taking psychiatric medicine or participating in research that they fear could associate them with a mental health diagnosis.
The team therefore focused on symptoms rather than trying to diagnose participants with depression or anxiety. Their larger question was whether early treatment could soften the psychological effects of trauma before they became more serious or persistent.
The research was published in the peer-reviewed Journal of Orthopaedic Trauma. The University of Florida team has now begun enrolling patients in a more rigorous follow-up trial in which participants receive fluoxetine or an inactive placebo without either the participants or researchers knowing who receives which treatment.
This next study should provide stronger evidence because the placebo-controlled, double-blind design reduces the influence of expectations and researcher bias. It will be especially important to see whether the reduction in PTSD symptoms remains when the treatment is tested in a larger group.
The current findings are encouraging but preliminary. The high dropout rate, small final sample and lack of blinding mean the study cannot establish that fluoxetine prevents PTSD after injury, and patients should not take the medicine for this purpose without medical guidance.
Still, the study asks an important question about trauma care. If future trials confirm the results, doctors may eventually have another way to support both physical and mental recovery during the vulnerable months after a life-changing injury.
If you care about mental health, please read studies that vegetarian diet may increase your depression risk, and Vitamin D could help reduce depression symptoms.
For more health information, please see recent studies about why pizza is a very addictive food, and MIND diet could improve cognitive health in older people.
Source: University of Florida.
